Kenneth D. Chi, MD Medical Director, GI Lab Advocate Lutheran General Hospital Center for Digestive Health May 7, 2016

Transcription

1 Kenneth D. Chi, MD Medical Director, GI Lab Advocate Lutheran General Hospital Center for Digestive Health May 7, 2016

2 Why have Quality Indicators? Pre-procedure Quality Indicators Intra-procedure Quality Indicators Post-procedure Quality Indicators What does this mean to us and how we practice?

3 >3.3 Million colonoscopies are done/yr USA ½ are done for screening and surveillence (2010 Data)

4 Transition of screening colonoscopy from a fee-for-service model to a Quality-based model Impact of these performance data on reimbursement rates from both CMS and third-party payers

5 Purpose of Quality Indicators 1. To reduce the frequency of missed colon cancers post colonoscopy 2. To minimize the risk to patients and to maximize the cost-effectiveness of CRC screening by minimizing the overuse of repeated colonoscopy

6 1. 100% adherence to each QI is not expected Cecal intubation (target is 95%, not 100%) 2. These QI are being implemented by CMS as well as many insurers as numeric targets that they expect endoscopists to report Our payments are going to be tied to our ability to report and to achieve high quality in our ability to meet certain numeric indicators

7 Documentation issues Informed consent is documented in > 98% Quality of bowel prep is documented in > 98% Withdrawal time is documented in >98% Appropriate Indication for Colonoscopy is documented in the report in >80% of patients Based on when they had their last colonoscopy Based on what their last pathology was <to reduce the frequency of inappropriate colonoscopy>

8 1. You should be able to get to the cecum > 95% of patients* You should have photodocumentation of the appendiceal orifice and the IC valve *If prep is poor (aborted) does NOT count towards calculation 2. Bowel Prep Documentation & Adequacy 3. Adenoma detection rate* *Priority Indicator

9 Bowel prep should be documented in >98% of the time Bowel prep should be Adequate 85% of the time New recommendations state there are only 2 options: 1. Adequate 2. Inadequate (unable to see polyps >5mm) Repeat colonoscopy in 1 YEAR suboptimal Can I bring patient back in 5 years? not really. This is not a rationale that is consistent with known data about missed colon cancers Doesn t take into account the fact that we are doing this to hopefully catch a missed adenoma before it actually turns into a colon cancer BUT this is not consistent with what we know about Missed Colon Cancers as the mean time to diagnosis of missed colon cancer are identified in only 3.5 years.

10 How do you calculate the ADR? Denominator = Total # patients who are at average risk getting a Screening colonoscopy Numerator = # of people where you find at least 1 adenoma Might be Simplistic : but fewer than 25% practices are reporting ADRs (survey data) 2006 Target ADR was 20% Now increased to 25% The reason is there is more data now the higher the ADR is, the less likely patients are found to have a missed colon cancer There was a 3% reduction in CRC incidence and 5% reduction in cancer mortality for each 1% increase in ADR

11

12

13

14

15 Document appropriate followup interval for their next colonoscopy in at least 90% patients* Normal = recommend Repeat 10 years 1 adenoma = recommend Repeat in 5 years We need to document the histology in some type of database and report to minimize overuse Perforations should be < 1:1000 Post-polypectomy bleeding should be <1% *Priority Indicator

16 As of 2015, all GIs are required to report the Quality Indicators through the physician quality reporting system (PQRS) CMS Requirements are being accepted by GIQuIC (ASGE/ACG benchmarking program) Our government is 2 years behind: In 2017 CMS will look at 2015 data to see how we did: 2% penalty if unable to hit these targets 2% additional penalty in reimbursement from CMS if GIs fail to report

17 Much has changed in how gastroenterologists perform colonoscopies from 10 years ago All colonoscopies are truly not created equal, but with these Quality Measures being imposed on us, we are trying to ensure good quality colonoscopies for our patients

18 Began March 1, 2016 Currently enrolled 102 patients 13 patients have been scheduled, and 8 procedures completed 27 patients did not meet criteria